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UPMC continues to comply with governmental guidance related to local, state, and federal COVID-19 vaccination for employment. All employees and affiliated staff of UPMC entities are considered essential health care workers and will be accountable to follow the Centers for Medicare & Medicaid Services (CMS) federal vaccine mandate. To be compliant with the federal mandate, employees must complete the approved vaccination dosage regimen currently defined by the federal government. Compliance with the federal mandate is encouraged before hire. Medical and religious exemption requests may be submitted for consideration.

For more information about UPMC’s response to COVID-19, please visit UPMC.com/coronavirus.

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   Current UPMC employees must apply in HR Direct

Manager, Actuarial Services- Affordable Care Act (Remote, US)

Description

UPMC Health Plan is seeking a Actuarial Manager of the Affordable Care Act!


Ensures that the Actuarial Department provides excellent services to various internal and external clients in the areas of pricing, reserving, forecasting, benefits and product development, provider relations/contracting, underwriting, and compliance. Responsible for supervising actuarial analysts. Responsible for stat and federal filings including actuarial certification. Presents to senior financial leadership team.

Any experience in the health insurance industry, specifically working with the Affordable Care Act products is preferred. 

The person selected for the role can work anywhere within the continental US. 


Responsibilities:

 

  • Provide pricing tools to enable Underwriting personnel to produce accurate price quotes on request from Sales and Marketing staff in a timely basis, along with appropriate supportive documents that may be needed to facilitate sales.
  • Work with the financial reporting department to develop reserve amounts for IBNR claims, active claims, and premium deficiency reserves on a regular or as-needed basis.
  • Ensure that departmental work products meet the highest standards of quality.
  • Supervise Actuarial and Underwriting department personnel to ensure that departmental objective and goals are achieved in a timely manner.
  • Work closely with the underwriting department.
  • Ascertain and comply with filing and actuarial requirements for participation in government-sponsored health plans as appropriate.
  • Provide Health Plan senior management with regular and ad hoc reports which communicate current and future near and long-term projections of financial performance of the various product lines in order to facilitate corporate decisions and the development of corporate strategies and goals.
  • Ensure that all required statutory rate filings are submitted appropriately and that all rates, factors, and methods are in compliance with applicable state and federal regulations.
  • Provide appropriate UPMC management with actuarial valuations of the impact of any proposed benefit changes or new product designs on an as-needed basis.
  • Provide reports for the purpose of evaluating and advising Health Plan management on the financial impact of proposed provider agreements or changes to existing agreements on an as-needed basis.
  • Work with the Health Plan-appointed actuary to ensure satisfactory filings of annual Statements of Actuarial Opinion and associated memorandum.
  • Work with Federal, State and regulatory auditors to resolve discrepancies.
  • Develop product pricing levels, factors, and methods to ensure premium and revenue flow adequate to cover medical and administrative costs and profit margins for the various product lines consistent with corporate strategic goals.
  • Advise Health Plan senior management on the financial impact of any special pricing or contract arrangements which may affect Health Plan financial profitability.
  • Direct the development and assessment of underwriting methods and tools in order to enhance the ability of underwriting staff to accurately identify and quantify risk to produce price quotes which appropriately match premium to risk.

 

Qualifications

  • Bachelor's degree in mathematics, statistics, actuarial science, economics, or related field required.
    • Advanced degree preferred.
  • Experience with the Affordable Care Act (ACA) is a must. 
  • Six and a half (6.5) years of experience in progressively more responsible actuarial work in health insurance/managed care or equivalent training/education.
  • Experience with commercial and government health programs is preferred.
  • In-depth understanding of health insurance market dynamics.
  • Excellent problem-solving and analytical skills.
  • Good oral and written communication skills. Strong PC skills.
  • Data retrieval skills and relational database experience.
  • Management experience preferred.

Total Rewards

More than just competitive pay and benefits, UPMC’s Total Rewards package cares for you in all areas of life — because we believe that you’re at your best when receiving the support you need: professional, personal, financial, and more.

Our Values

At UPMC, we’re driven by shared values that guide our work and keep us accountable to one another. Our Values of Quality & Safety, Dignity & Respect, Caring & Listening, Responsibility & Integrity, Excellence & Innovation play a vital role in creating a cohesive, positive experience for our employees, patients, health plan members, and community. Ready to join us? Apply today.

   Current UPMC employees must apply in HR Direct